Endoscopic management of esophageal perforations: a multi-center study

Area of Science:

• Gastroenterology
• Surgical Innovation
• Medical Device Technology

Background:

• Esophageal perforation (EP) is a rare, life-threatening condition with significant morbidity and mortality.
• Iatrogenic injury during endoscopy is the leading cause, but spontaneous, traumatic, and malignant etiologies also exist.
• Nonspecific symptoms and diagnostic delays in EP are linked to poorer patient outcomes.

Purpose of the Study:

• To evaluate the effectiveness of various non-operative management strategies for esophageal perforation.
• To identify key predictors associated with successful non-surgical repair of EP.

Main Methods:

• Retrospective analysis of 72 adult patients with EP across three Mayo Clinic sites (2007-2023).
• Patients were classified into four groups based on treatment: primary closure, stenting, combination therapy, and conservative management.
• Clinical success (avoidance of surgery) was the primary outcome, assessed using logistic regression.

Main Results:

• Non-operative management achieved 100% success with primary closure and combination therapy.
• Conservative management showed a success rate of only 42.9%.
• Non-conservative therapies were significant predictors of successful repair (aOR 22.4, p=0.036).

Conclusions:

• Primary closure and combination endoscopic approaches yield superior outcomes for esophageal perforation.
• Timely intervention and appropriate modality selection are crucial for avoiding surgical escalation and improving prognosis in EP patients.